Biomarker Panel for Non-Invasive Diagnosis of Congenital Renal Dysfunction

ABSTRACT

Disclosed herein are methods and compositions for prognosing or diagnosing an obstructive renal dysfunction or ureteropelvic junction obstruction (UPJO) in a subject, involving detecting in a urine sample from a subject one or more proteins selected from the group consisting of Immunoglobulin superfamily containing leucine-rich repeat protein (ISLR); 
     Nicotinate-nucleotide pyrophosphorylase [carboxylating] (QPRT); Prostaglandin reductase 1 (PTGR1); Vascular cell adhesion protein 1 (VCAM1); and Ficolin-2 (FCN2), or detectable portions thereof to identify the subject as at risk of or having an obstructive renal dysfunction or UPJO.

CROSS REFERENCE

This application claims priority to U.S. Provisional Application Ser. No. 63/161,601 filed Mar. 16, 2021, incorporated by reference herein in its entirety.

STATEMENT OF GOVERNMENT SUPPORT

This invention was made with government support under Grant No.HL127449 from the National Institutes of Health. The government has certain rights in the invention.

SEQUENCE LISTING STATEMENT

A computer readable form of the Sequence Listing is filed with this application by electronic submission and is incorporated into this application by reference in its entirety. The Sequence Listing is contained in the file created on March 14, 2022 having the file name “22-0360-US-SeqList_ST25.txt” and is 21 kb in size.

FIELD OF DISCLOSURE

The disclosure contained herein is in the general field of identification of people with congenital renal dysfunction, including children with obstructive renal dysfunction, such as resulting from ureteropelvic junction obstruction (UPJO).

BACKGROUND

Ureteropelvic junction obstruction (UPJO) is one of the obstructive congenital anomalies of the kidney and urinary tract (CAKUT) and represents the most common cause of chronic kidney disease in children. Advances in maternal sonography have improved early detection of UPJO, however hydronephrosis does not necessarily equate to obstruction. While surgical intervention is successful when nuclear medicine studies confirm obstruction, these studies are invasive. In some situations, a ‘watchful waiting’ approach is adopted for asymptomatic infants, entailing periodic assessment of function by radiotracer-extraction studies that are cumbersome and often are equivocal. Current therapeutic goals focus on halting progressive injury and enhancing subsequent healing. However, progress in these areas is severely hampered by the paucity of reliable biomarkers to assess the effects of obstruction.

SUMMARY

In one aspect, the disclosure provides methods for prognosing or diagnosing an obstructive renal dysfunction in a subject, comprising:

(a) detecting in a urine sample from a subject one or more proteins selected from the group consisting of Immunoglobulin superfamily containing leucine-rich repeat protein (ISLR); Nicotinate-nucleotide pyrophosphorylase [carboxylating] (QPRT); Prostaglandin reductase 1 (PTGR1); Vascular cell adhesion protein 1 (VCAM1); and Ficolin-2 (FCN2), or detectable portions thereof; and

(b) comparing an amount of the one or more proteins in the urine sample to a standard;

wherein an amount of at least one of the one or more proteins in the urine sample above the standard identifies the subject as at risk of or having an obstructive renal dysfunction.

In one embodiment, an amount of at least one of the one or more proteins in the urine sample above the standard identifies the subject as at risk of or having an obstructive renal dysfunction resulting from ureteropelvic junction obstruction (UPJO).

In one embodiment, wherein the detecting comprises contacting the urine sample with antibodies that bind to the one or more proteins, and detecting binding of the antibodies to the one or more proteins. In another embodiment, the method comprises identifying the subject as having an obstructive renal dysfunction or UPJO, and wherein the method further comprises treating the subject for the obstructive renal dysfunction or UPJO.

In another aspect, the disclosure provides compositions, comprising antibodies that specifically bind 2, 3, 4, or all 5 proteins selected from the group consisting of ISLR, QPRT, PTGR1, VCAM1, and FCN2, or antigen binding portions thereof. In one embodiment, the antibodies are immobilized on a surface of a solid support. In another embodiment, the antibodies are detectably labeled, such as fluorescently labeled, radioactively labeled, or colorimetrically labeled.

DESCRIPTION OF THE FIGURES

FIG. 1(A-C). Mass spectrometric identification of 10 candidate biomarker proteins present in UPJO but absent in control patients. (A) Methodology employed to identify UPJO-inherent urinary proteins. (B) Odds ratio analysis of top 10 UPJO-inherent urinary proteins identified by mass spectrometry analysis. Average precursor intensities of individual proteins was used to stratify control and UPJO samples according to the presence or absence of candidate proteins. Odds ratio was calculated for each protein as shown in the table. LCN2 was included for comparative analysis. (C) List of the top ten ranked biomarker proteins.

FIG. 2(A-D). Validation of PTGR1, FCN2, QPRT, ISLR and VCAM1 as a panel of UPJO-inherent urinary biomarker proteins. (A) Normalized PTGR1, FCN2, QPRT, ISLR and VCAM1 amounts in control and UPJO samples. Individual protein concentrations (ng/mL) were determined using commercial ELISA kits and normalized to respective urine creatinine concentrations (mg/dL) to obtain protein/creatinine in ng/mg. Data is represented as median (IQR). PTGR1 control (n=18), median (IQR)=118.81 (69.73-152.58); PTGR1 UPJO (n=18), median (IQR)=607.64 (493.13-718.67); FCN2 control (n=18), median (IQR)=11.86 (5.74-23.72); FCN2 UPJO (n=18), median (IQR)=111.82 (77.44-150.73); QPRT control (n=20), median (IQR)=61.30 (25.30-83.56); QPRT UPJO (n=18), median (IQR)=271.79 (157.66-512.80)); ISLR control (n=21), median (IQR)=50.34 (31.43-81.37); ISLR UPJO (n=18), median (IQR)=144.85 (97.78-256.37); VCAM1 control (n=21), median (IQR)=20.38 (10.16-85.42)) and VCAM1 UPJO (n=18), median (IQR)=187.30 (118.49-475.57). Statistical analysis on PTGR1 control and UPJO samples was performed using 2-tailed Student's t test while the rest of the comparative analyses were performed using 2-tailed Mann Whitney test. **p≤0.01, ***p≤0.001, IQR—Interquartile range. (B) Fold change of medians (UPJO/control) of normalized PTGR1, FCN2, QPRT, ISLR and VCAM1 proteins. (C) Classification of UPJO samples based on the average+3(SD) value of control samples. Average and SD of individual proteins in control samples as determined from ELISA was used to identify UPJO samples with values greater than the average+3(SD) value of respective control samples. Boxes with a “YES” indicate samples with values greater than the average+3(SD) value of control samples, while the boxes with an “x” indicate samples with values smaller than the average+3(SD) value of control samples. Number of positive samples for each protein as well as the number of positive proteins in each sample are enumerated in the table. SD—standard deviation. (D) Summary of percent positive control and UPJO samples. Control and UPJO samples with values greater than the average+3(SD) and average+4(SD) value of respective control samples were enumerated and percent positive samples have been tabulated. SD—standard deviation.

DETAILED DESCRIPTION

All references cited are herein incorporated by reference in their entirety. Within this application, unless otherwise stated, the techniques utilized may be found in any of several well-known references such as: Molecular Cloning: A Laboratory Manual (Sambrook, et al., 1989, Cold Spring Harbor Laboratory Press), Gene Expression Technology (Methods in Enzymology, Vol. 185, edited by D. Goeddel, 1991. Academic Press, San Diego, Calif.), “Guide to Protein Purification” in Methods in Enzymology (M. P. Deutshcer, ed., (1990) Academic Press, Inc.); PCR Protocols: A Guide to Methods and Applications (Innis, et al. 1990. Academic Press, San Diego, Calif.), Culture of Animal Cells: A Manual of Basic Technique, 2^(nd) Ed. (R. I. Freshney. 1987. Liss, Inc. New York, N.Y.), and Gene Transfer and Expression Protocols, pp. 109-128, ed. E. J. Murray, The Humana Press Inc., Clifton, N.J.

As used herein, the singular forms “a”, “an” and “the” include plural referents unless the context clearly dictates otherwise. “And” as used herein is interchangeably used with “or” unless expressly stated otherwise.

All embodiments of any aspect of the disclosure can be used in combination, unless the context clearly dictates otherwise.

Disclosed herein is a panel of biomarkers that are can be used to prognose or diagnose obstructive renal dysfunction and improve upon current detection methods.

It is an object of the disclosed panel and methods associated with it that clinicians and clinical laboratories will use this panel to non-invasively and cost-effectively identify subjects, including but not limited to infants and children with obstructive dysfunction.

In one aspect, the disclosure provides method for prognosing or diagnosing obstructive renal dysfunction in a subject, comprising:

(a) detecting in a urine sample from a subject one or more proteins selected from the group consisting of Immunoglobulin superfamily containing leucine-rich repeat protein (ISLR); Nicotinate-nucleotide pyrophosphorylase [carboxylating] (QPRT); Prostaglandin reductase 1 (PTGR1); Vascular cell adhesion protein 1 (VCAM1); and Ficolin-2 (FCN2), or detectable portions thereof; and

(b) comparing an amount of the one or more proteins in the urine sample to a standard;

wherein an amount of at least one of the one or more proteins in the urine sample above the standard identifies the subject as at risk of or having an obstructive renal dysfunction.

The methods may be used to prognose or diagnose any obstructive renal dysfunction. An obstructive renal dysfunction is any condition in which a ureteral blockage obstructs the normal passage of urine to the bladder, leading to accumulation of urine into one or both kidneys, causing detrimental swelling and stretching. In congenital ureteral obstruction, partial or complete obstruction of one or both of the ureters prevents or impedes the flow of urine into the bladder from the kidney. An early effect of ureteral obstruction is an increase in pressure in the proximal tubules causing distention, damage and shedding of proteins expressed on the apical surface of the proximal tubular brush border epithelium into the urine. In its most severe form, urinary tract obstruction can lead to prenatal or early infant death. Other children may progress to develop chronic kidney disease and kidney failure requiring lifelong monitoring and renal replacement therapy. Moreover, all of these patients are at a greater risk of developing early cardiovascular disease. The severity and location of the obstruction and the timing of its relief affect outcomes; current therapeutic goals focus on halting progressive injury and enhancing subsequent healing.

In various non-limiting embodiments, the obstructive renal dysfunction results from ureteropelvic junction obstruction (UPJO), Vesicoureteral Reflux (VUR), Ureterovesical Junction Obstruction (UVJ), posterior ureteral valves (PUV), ureterocele, or ectopic ureter. Each of these conditions interferes with normal urine flow from the kidney to the bladder. UPJO refers to a blockage in the area that connects the renal pelvis (part of the kidney) to one of the tubes (ureters) that move urine to the bladder. VUR occurs when one or both ureters are not positioned appropriately or have poor muscle connections to the bladder. UVJ is a distinct type of blockage in the area where the ureter meets the bladder; PUV are leaflets, or extra flaps of tissue, that develop in the male urethra that impede urine flow and bladder emptying; ureterocele blockage in one or more of the ureters, preventing the normal flow of urine. A ureterocele is a balloon-like blockage of the ureter closer to the bladder; ectopic ureter refers to the condition where the connection between the ureter and the bladder does not form properly and drains somewhere outside of the bladder. These congenital anomalies of the kidney and urinary tract (CAKUT) occur in 1 in 100 to 500 newborns, can be severe and lead to lead to chronic kidney disease and hypertension, which can affect a child's growth and development, requiring lifetime monitoring. CAKUT patients are also at a greater risk for cardiovascular disease. Surgery is needed in cases of compromised kidney function.

In one non-limiting embodiment, the obstructive renal dysfunction results from UPJO.

The subject may be any subject at risk of having obstructive renal dysfunction. In one embodiment, the subject is a mammal, such as a human subject. In another non-limiting embodiment, the subject may be a child (i.e.: less than 18 years of age); in another embodiment, the subject may be an infant or young child (i.e.: under the age of 3 years old, or under the age of three years old). In another embodiment, the subject is a male subject.

In one embodiment, a subject at risk of having obstructive renal dysfunction (including but not limited to UPJO) may be one presenting with one or more symptoms selected from back or flank pain, bloody urine (hematuria), lump in the abdomen (abdominal mass), kidney infection, poor growth in infants (failure to thrive), urinary tract infection, usually with fever, and/or vomiting.

Any standard may be used as deemed suitable by attending medical personnel. In one embodiment, the standard comprises a normal range determined from subjects not having an obstructive renal dysfunction. In this embodiment, the normal range may be a predetermined range used for comparison to the amount determined in the subject. In another embodiment, the standard may comprise a normal range determined from subjects not having UPJO. In these embodiments, an amount of at least one of the one or more proteins in the urine sample above the standard identifies the subject as at risk of or having an obstructive renal dysfunction.

Any amount of the one or more proteins above standard may identify the subject as at risk of or having an obstructive renal dysfunction. In various embodiments, an amount of the one or more proteins 10%, 20%, 30%, 40%, 50%, 60%, 70%, 80%, 90%, 100%, or more above standard may identify the subject as at risk of or having an obstructive renal dysfunction. In another embodiment, the standard may be that none of the one or more proteins are detectable in normal urine, and thus any amount of the one or more proteins may identify the subject as at risk of or having an obstructive renal dysfunction.

In various embodiments, an amount of at least 2, 3, 4, or all 5 of the one or more proteins in the urine sample above the standard identifies the subject as at risk of or having an obstructive renal dysfunction. In one embodiment, an amount of PTGR1 in the urine sample above the standard identifies the subject as at risk of or having an obstructive renal dysfunction. In another embodiment, an amount of PTGR1 and FCN2 in the urine sample above the standard identifies the subject as at risk of or having an obstructive renal dysfunction. In a further embodiment, an amount of PTGR1, FCN2, and QPRT in the urine sample above the standard identifies the subject as at risk of or having an obstructive renal dysfunction. In one embodiment, an amount of PTGR1, FCN2, QPRT, and ISLR in the urine sample above the standard identifies the subject as at risk of or having an obstructive renal dysfunction.

Urine samples may be obtained and processed (though processing is not required) from the subject using standard techniques. The protein markers, or detectable portions thereof can be detected in the urine samples using standard techniques. As will be understood by those of skill in the art, the specific amino acid sequence of the markers in different subjects may differ. In various non-limiting embodiments, the one or more proteins in the urine sample, or detectable portions thereof, have an amino acid sequence at least 75%, 80%, 85%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, or 100% identical to the amino acid sequence of one or more of SEQ ID NOS:1-5, or detectable portions thereof. As will be understood by those of skill in the art, the proteins in the urine may have undergone degradation, proteolytic cleavage, etc., and thus the methods comprise detecting detectable portions of the proteins.

ISLR UniProtKB - Q6UXK2  >sp|Q6UXK2|ISLR2 HUMAN Immunoglobulin superfamily containing leucine-rich  repeat protein 2 OS = Homo sapiens OX = 9606 GN = ISLR2 PE = 1 SV = 1  (SEQ ID NO: 1) MFPLRALWLVWALLGVAGSCPEPCACVDKYAHQFADCAYKELREVPEGLPANVTTLSLSA  NKITVLRRGAFADVTQVTSLWLAHNEVRTVEPGALAVLSQLKNLDLSHNFISSFPWSDLR  NLSALQLLKMNHNRLGSLPRDALGALPDLRSLRINNNRLRTLAPGTFDALSALSHLQLYH  NPFHCGCGLVWLQAWAASTRVSLPEPDSIACASPPALQGVPVYRLPALPCAPPSVHLSAE  PPLEAPGTPLRAGLAFVLHCIADGHPTPRLQWQLQIPGGTVVLEPPVLSGEDDGVGAEEG  EGEGDGDLLTQTQAQTPTPAPAWPAPPATPRFLALANGSLLVPLLSAKEAGVYTCRAHNE  LGANSTSIRVAVAATGPPKHAPGAGGEPDGQAPTSERKSTAKGRGNSVLPSKPEGKIKGQ  GLAKVSILGETETEPEEDTSEGEEAEDQILADPAEEQRCGNGDPSRYVSNHAFNQSAELK  PHVFELGVIALDVAEREARVQLTPLAARWGPGPGGAGGAPRPGRRPLRLLYLCPAGGGAA  VQWSRVEEGVNAYWERGLRPGTNYSVCLALAGEACHVQVVESTKKELPSLLVIVAVSVFL  LVLATVPLLGAACCHLLAKHPGKPYRLILRPQAPDPMEKRIAADFDPRASYLESEKSYPA  GGEAGGEEPEDVQGEGLDEDAEQGDPSGDLQREESLAACSLVESQSKANQEEFEAGSEYS  DRLPLGAEAVNIAQEINGNYRQTAG  QPRT: UniProtKB - Q15274  >sp|Q15274|NADC_HUMAN Nicotinate-nucleotide pyrophosphorylase [carboxylating]  OS = Homo sapiens OX = 9606 GN = QPRT PE = 1 SV = 3  (SEQ ID NO: 2) MDAEGLALLLPPVTLAALVDSWLREDCPGLNYAALVSGAGPSQAALWAKSPGVLAGQPFF  DAIFTQLNCQVSWFLPEGSKLVPVARVAEVRGPAHCLLLGERVALNTLARCSGIASAAAA  AVEAARGAGWTGHVAGTRKTTPGFRLVEKYGLLVGGAASHRYDLGGLVMVKDNHVVAAGG  VEKAVRAARQAADFTLKVEVECSSLQEAVQAAEAGADLVLLDNFKPEELHPTATVLKAQF  PSVAVEASGGITLDNLPQFCGPHIDVISMGMLTQAAPALDFSLKLFAKEVAPVPKIH  PTGR1: UniProtKB - Q14914  sp|Q14914|PTGR1_HUMAN Prostaglandin reductase 1 OS = Homo sapiens OX = 9606  GN = PTGR1 PE = 1 SV = 2  (SEQ ID NO: 3) MVRTKTWTLKKHFVGYPTNSDFELKTAELPPLKNGEVLLEALFLTVDPYMRVAAKRLKEG  DTMMGQQVAKVVESKNVALPKGTIVLASPGWTTHSISDGKDLEKLLTEWPDTIPLSLALG  TVGMPGLTAYEGLLEICGVKGGETVMVNAAAGAVGSVVGQIAKLKGCKVVGAVGSDEKVA  YLQKLGFDVVFNYKTVESLEETLKKASPDGYDCYFDNVGGEFSNTVIGQMKKFGRIAICG  AISTYNRTGPLPPGPPPEIVIYQELRMEAFVVYRWQGDARQKALKDLLKWVLEGKIQYKE  YIIEGFENMPAAFMGMLKGDNLGKTIVKA  VCAM1: UniProtKB - P19320  >sp|P19320|VCAM1_HUMAN Vascular cell adhesion protein 1 OS = Homo sapiens  OX = 9606 GN = VCAM1 PE = 1 SV = 1  (SEQ ID NO: 4) MPGKMVVILGASNILWIMFAASQAFKIETTPESRYLAQIGDSVSLTCSTTGCESPFFSWR  TQIDSPLNGKVTNEGTTSTLTMNPVSFGNEHSYLCTATCESRKLEKGIQVEIYSFPKDPE  IHLSGPLEAGKPITVKCSVADVYPFDRLEIDLLKGDHLMKSQEFLEDADRKSLETKSLEV  TFTPVIEDIGKVLVCRAKLHIDEMDSVPTVRQAVKELQVYISPKNTVISVNPSTKLQEGG  SVTMTCSSEGLPAPEIEWSKKLDNGNLQHLSGNATLTLIAMRMEDSGIYVCEGVNLIGKN  RKEVELIVQEKPFTVEISPGPRIAAQIGDSVMLTCSVMGCESPSFSWRTQIDSPLSGKVR  SEGTNSTLTLSPVSFENEHSYLCTVTCGHKKLEKGIQVELYSFPRDPEIEMSGGLVNGSS  VTVSCKVPSVYPLDRLEIELLKGETILENIEFLEDTDMKSLENKSLEMTFIPTIEDTGKA  LVCQAKLHIDDMEFEPKQRQSTQTLYVNVAPRDTTVLVSPSSILEEGSSVNMTCLSQGFP  APKILWSRQLPNGELQPLSENATLTLISTKMEDSGVYLCEGINQAGRSRKEVELIIQVTP  KDIKLTAFPSESVKEGDTVIISCTCGNVPETWIILKKKAETGDTVLKSIDGAYTIRKAQL  KDAGVYECESKNKVGSQLRSLTLDVQGRENNKDYFSPELLVLYFASSLIIPAIGMITYFA  RKANMKGSYSLVEAQKSKV  FCN2: UniProdKB - Q15485  >sp|Q15485|FCN2_HUMAN Ficolin-2 OS = Homo sapiens OX = 9606 GN = FCN2 PE = 1 SV = 2  (SEQ ID NO: 5) MELDRAVGVLGAATLLLSFLGMAWALQAADTCPEVKMVGLEGSDKLTILRGCPGLPGAPG  PKGEAGTNGKRGERGPPGPPGKAGPPGPNGAPGEPQPCLTGPRTCKDLLDRGHFLSGWHT  IYLPDCRPLTVLCDMDTDGGGWTVFQRRVDGSVDFYRDWATYKQGFGSRLGEFWLGNDNI  HALTAQGTSELRVDLVDFEDNYQFAKYRSFKVADEAEKYNLVLGAFVEGSAGDSLTFHNN  QSFSTKDQDNDLNTGNCAVMFQGAWWYKNCHVSNLNGRYLRGTHGSFANGINWKSGKGYN  YSYKVSEMKVRPA 

Detecting the presence of the protein markers can be carried out using any suitable techniques. In various non-limiting embodiments, the detecting may comprise use of mass spectroscopy or Western blotting to detect the one or more proteins present in the urine sample. In another embodiment, the detecting comprises use of antibodies to detect the one or more proteins. In some embodiments, the methods may comprise using (for each protein marker to be detected) a single antibody that specifically binds to a single one of the protein markers, or may comprise using a plurality (2, 3, 4, 5, or more) of antibodies that each specifically bind to the same protein marker, but bind to different epitopes on the protein marker. This latter embodiment may be particularly useful if the protein may be be partially degraded in the urine sample. In one such embodiment, an enzyme-linked immunosorbent assay (ELISA) is used. ELISAs can be carried out using standard techniques and antibodies that selectively bind to the one or more proteins. In one embodiment, a sandwich ELISA can be used in which two antibodies that recognize different epitopes of the same protein are used, one as the ‘capture antibody’ that is fixed to a solid surface such as a plate or well, and the second is the ‘detecting antibody’ that is labeled with an detectable label (fluorescent, radioactive, colorimetric, etc.)

In another embodiment, the method comprises identifying the subject as having an obstructive renal dysfunction, and wherein the method further comprises treating the subject for the obstructive renal dysfunction. In a further embodiment, the method comprises identifying the subject as having UPJO, and wherein the method further comprises treating the subject for UPJO.

The traditional treatment for UPJO has been open surgery to cut out the area of scarring and re-connect the ureter to the kidney. Over the past several years, newer less invasive treatment options have been developed. Endopyelotomy is a procedure through which a telescope or balloon with an electric wire on it is passed to the level of the kidney. The scar tissue is then cut open from the inside. These procedures can be done in a short period of time as an outpatient with minimal anesthetic and with a much shorter recuperation than with open surgery. Patients will have to keep a temporary internal tube (stent) for four to six weeks. The radiographic success rate with these procedures are 15%-20% lower than what is obtained with open surgery. Moreover, 40% of patients may have significant persistent pain following procedure. Laparoscopic pyeloplasty was developed in order to give the same high success rate obtained with open pyeloplasty while decreasing the morbidity. The internal procedure is performed in the same manner as the open surgery without the need for a large incision. Postoperative pain is less, recuperation is significantly quicker and scarring is minimal when compared with open surgery. The procedure requires a general anesthetic and hospitalization (usually 2 nights). An internal stent is also needed for four weeks. Success with this procedure is the same as open surgery (>95%).

Congenital obstructive renal anomalies are one of the most common causes of renal replacement therapies in children. Timely diagnosis and intervention can circumvent these consequences. Current diagnostic techniques are invasive, costly and imprecise. This diagnostic panel would replace current diagnostic modalities in a simple, non-invasive, cost-effective urine test.

The methods may also be used to assess efficacy of a therapeutic treatment for obstructive renal dysfunction or UPJO. In one embodiment, the methods further comprise;

(a) detecting one or more proteins selected from the group consisting of ISLR, QPRT, PTGR1, VCAM1, and FCN2, or detectable portions thereof, in a urine sample from a subject that has undergone treatment for the obstructive renal dysfunction or UPJO; and

(b) comparing an amount of the one or more proteins in the urine sample to a standard;

wherein a decrease in the amount of the or more (1, 2, 3, 4, or all 5) proteins in the urine sample relative to the standard indicates the treatment was effective; or

wherein no change or an increase in the amount of the one or more (1, 2, 3, 4, or all 5) proteins in the urine sample relative to the standard indicates the treatment was ineffective.

In this embodiment, the standard will typically be an amount of the one or more proteins in an earlier urine sample from the subject, prior to the treatment. In this embodiment, if no change or an increase in the amount of the one or more proteins in the urine sample relative to the standard indicates the treatment was ineffective, and wherein the method further comprises administering a further treatment to the subject to treat the obstructive renal dysfunction or UPJO.

In another aspect, the disclosure provides compositions, comprising antibodies that specifically bind 2, 3, 4, or all 5 proteins selected from the group consisting of ISLR, QPRT, PTGR1, VCAM1, and FCN2, or antigen binding portions thereof. The compositions can be used, for example, in the diagnostic and prognostic methods of the disclosure. In one embodiment, the composition comprises antibodies that specifically bind PTGR1, or antigen binding portions thereof. In another embodiment, the composition comprises antibodies that specifically bind FCN2, or antigen binding portions thereof. In a further embodiment, the composition comprises antibodies that specifically bind QPRT, or antigen binding portions thereof.

In one embodiment, the composition comprises

(a) antibodies that specifically bind PTGR1, or antigen binding portions thereof; and

(b) antibodies that specifically bind FCN2, or antigen binding portions thereof.

In another embodiment, the composition comprises

(a) antibodies that specifically bind PTGR1, or antigen binding portions thereof;

(b) antibodies that specifically bind FCN2, or antigen binding portions thereof; and

(c) antibodies that specifically bind QPRT, or antigen binding portions thereof.

In a further embodiment, the composition comprises antibodies that specifically bind ISLR, or antigen binding portions thereof. In another embodiment, the composition comprises antibodies that specifically bind VCAM1, or antigen binding portions thereof.

In one embodiment, the composition comprises

(a) antibodies that specifically bind PTGR1, or antigen binding portions thereof;

(b) antibodies that specifically bind FCN2, or antigen binding portions thereof;

(c) antibodies that specifically bind QPRT, or antigen binding portions thereof;

(d) antibodies that specifically bind ISLR, or antigen binding portions thereof; and

(e) antibodies that specifically bind VCAM1, or antigen binding portions thereof.

The compositions can be stored frozen, in lyophilized form, or as a solution. In one embodiment, the peptides may be immobilized on a surface of a solid support. Any suitable solid support may be used. Examples of such supports include, but are not limited to, microarrays, beads, columns, optical fibers, wipes, nitrocellulose, nylon, glass, quartz, diazotized membranes (paper or nylon), silicones, polyformaldehyde, cellulose, cellulose acetate, paper, ceramics, metals, metalloids, semiconductive materials, coated beads, magnetic particles; plastics such as polyethylene, polypropylene, and polystyrene; and gel-forming materials, such as proteins (e.g., gelatins), lipopolysaccharides, silicates, agarose, polyacrylamides, methylmethracrylate polymers; sol gels; porous polymer hydrogels; nanostructured surfaces; nanotubes (such as carbon nanotubes), and nanoparticles (such as gold nanoparticles or quantum dots). This embodiment facilitates use of the compositions in various detection assays.

In a specific embodiment, the composition comprises capture antibodies that specifically bind the one or more proteins are directly adsorbed on plastic (such as polystyrene) and modified with an avidin-biotin system to increase antigen capture in detection assays, such as ELISAs. Adsorption of proteins on polystyrene is noncovalent and proportional to the amount added for up to 150 ng/200 microliter in a microtiter well.

In another embodiment, the antibodies may be labeled with a detectable label. Any suitable detectable label can be used, including but not limited fluorescent, radioactive, or colorimetric labels. In one embodiment, the detectable labels for each antibody type are detectable distinguishable. Methods for detecting the label include, but are not limited to spectroscopic, photochemical, biochemical, immunochemical, physical or chemical techniques.

All documents cited herein are expressly incorporated herein in their entirety to the same extent as if each document or cited publication/patent document was individually and expressly incorporated herein:

While the invention has been described with reference to preferred embodiments, it will be understood by those skilled in the art that various changes may be made and equivalents may be substituted for the elements thereof without departing from the scope of the invention. In addition, many modifications may be made to adapt the teaching of the invention to particular use, application, manufacturing conditions, use conditions, composition, medium, size, and/or materials without departing from the essential scope and spirit of the invention. Therefore, it is intended that the invention not be limited to the particular embodiments and best mode contemplated for carrying out this invention as described herein. Since many modifications, variations, and changes in detail can be made to the described examples, it is intended that all matters in the preceding description and shown in the accompanying figures be interpreted as illustrative and not in a limiting sense.

All ranges disclosed herein are inclusive of the endpoints, and the endpoints are independently combinable with each other. Each range disclosed herein constitutes a disclosure of any point or sub-range lying within the disclosed range.

The use of the terms “a” and “an” and “the” and words of a similar nature in the context of describing the improvements disclosed herein are to be construed to cover both the singular and the plural, unless otherwise indicated herein or clearly contradicted by context. Further, it should further be noted that the terms “first,” “second,” and the like herein do not denote any order, quantity, or relative importance, but rather are used to distinguish one element from another.

All methods described herein can be performed in any suitable order unless otherwise indicated herein or otherwise clearly contradicted by context. The use of any and all examples, or exemplary language (e.g., “such as”), is intended merely to better illustrate the invention and does not pose a limitation on the scope of the invention or any embodiments unless otherwise claimed.

EXAMPLES Abstract

Reliable urinary biomarker proteins would be invaluable in identifying children with ureteropelvic junction obstruction (UPJO); to this end, total protein from control (n=22) and UPJO (n=21) urine samples was analyzed by mass spectrometry and candidate biomarker proteins were ranked according to their diagnostic odds ratio. The top ten proteins with highest odds ratio were tested by ELISA and normalized to urine creatinine levels. Five of the 10 proteins — prostaglandin-reductase-1, ficolin-2, nicotinate-nucleotide pyrophosphorylase [carboxylating], immunoglobulin superfamily-containing leucine-rich-repeat-protein and vascular cell adhesion molecule-1 were present at higher levels in the UPJO samples and emerged as a panel of biomarkers to identify obstructive uropathy.

In this study, we implemented quantitative label-free mass spectrometry-based proteomics analysis of UPJO patient and control urine samples to identify proteins that are preferentially present in UPJO patients (UPJO-inherent). We validated these findings with ELISA and generated a panel of 5 biomarker proteins (PTGR1, FCN2, QPRT, ISLR and VCAM1) that form a UPJO-inherent signature.

Results Identification of UPJO-Inherent Candidate Biomarker Proteins

To minimize initial variability in the urine-proteome, age-restricted (<2 years) and gender-matched cohort of UPJO patients (n=21) and hypospadias repair controls (n=22) were selected (FIG. 1a and Table 1).

TABLE 1 Control and UPJO patient characteristics Sample Sex Age Weight Notes Control-1 M 10 months 9.15 kg Used for mass spectrometric analysis and ELISA Control-2 M 9 months 10 kg Used for mass spectrometric analysis and ELISA Control-3 M 7 months 7.65 kg Used for mass spectrometric analysis and ELISA Control-4 M 10 months 7.95 kg Used for mass spectrometric analysis and ELISA Control-5 M 19 months 11.8 kg Used for mass spectrometric analysis and ELISA Control-6 M 5 months 6.5 kg Used for mass spectrometric analysis and ELISA Control-7 M 8 months 9.15 kg Used for mass spectrometric analysis and ELISA Control-8 M 9 months 8.8 kg Used for mass spectrometric analysis and ELISA Control-9 M 6 months 7.8 kg Used for mass spectrometric analysis and ELISA Control-10 M 10 months 8.89 kg Used for mass spectrometric analysis and ELISA Control-11 M 6 months 7.68 kg Used for mass spectrometric analysis and ELISA Control-12 M 9 months 8.2 kg Used for mass spectrometric analysis Control-13 M 6 months 7.8 kg Used for mass spectrometric analysis and ELISA Control-14 M 6 months 7.7 kg Used for mass spectrometric analysis and ELISA Control-15 M 12 months 8.3 kg Used for mass spectrometric analysis and ELISA Control-16 M 8 months 10.1 kg Used for mass spectrometric analysis and ELISA Control-17 M 9 months 8.8 kg Used for mass spectrometric analysis and ELISA Control-18 M 6 months 8.5 kg Used for mass spectrometric analysis and ELISA Control-19 M 8 months 6.2 kg Used for mass spectrometric analysis and ELISA Control-20 M 6 months 7.9 kg Used for mass spectrometric analysis and ELISA Control-21 M 6 months 10.3 kg Used for mass spectrometric analysis and ELISA Control-22 M 8 months 8.9 kg Used for mass spectrometric analysis and ELISA UPJO-1 M 8 months 9.15 kg Used for ELISA UPJO-2 M 12 months 7.75 kg Used for mass spectrometric analysis and ELISA UPJO-3 M 5 months 7.6 kg Used for mass spectrometric analysis and ELISA UPJO-4 M 3 months 6.2 kg Used for mass spectrometric analysis and ELISA UPJO-5 M 3 months 6.2 kg Used for mass spectrometric analysis and ELISA UPJO-6 M 7 months No info Used for mass spectrometric analysis UPJO-7 M 3 months No info Used for mass spectrometric analysis UPJO-8 M 15 months No info Used for mass spectrometric analysis UPJO-9 M 5 months 7.5 kg Used for mass spectrometric analysis and ELISA UPJO-10 M 2 months 4.8 kg Used for mass spectrometric analysis and ELISA UPJO-11 M 8 months 8.1 kg Used for mass spectrometric analysis and ELISA UPJO-12 M 4 months 5.9 kg Used for mass spectrometric analysis and ELISA UPJO-13 M 4 months 6.4 kg Used for mass spectrometric analysis and ELISA UPJO-14 M 2 months 7.65 kg Used for mass spectrometric analysis and ELISA UPJO-15 M 6 weeks 5.6 kg Used for mass spectrometric analysis and ELISA UPJO-16 M 10 weeks 6.8 kg Used for mass spectrometric analysis and ELISA UPJO-17 M 10 weeks 4.89 kg Used for mass spectrometric analysis and ELISA UPJO-18 M 9 months 9.45 kg Used for mass spectrometric analysis and ELISA UPJO-19 M 7 months 10.3 kg Used for mass spectrometric analysis and ELISA UPJO-20 M 12 months 10.8 kg Used for mass spectrometric analysis and ELISA UPJO-21 M 10 months 5.5 kg Used for mass spectrometric analysis UPJO-22 M 6 months 7.6 kg Used for mass spectrometric analysis and ELISA

Due to the limited availability, some of the samples were only used for either mass spectrometric analysis or ELISA and have been identified in the notes. We analyzed urine samples using quantitative, label-free mass spectrometry-based proteomics and calculated the average precursor intensities of identified proteins. Subsequently, a two-step selection process was used to identify candidate biomarker proteins that are more likely to be present in UPJO patients and absent in controls, termed UPJO-inherent. In the first step, we identified 171 proteins that were not detected in the majority of the control samples (16/22 samples, or 72.7%). Accordingly, subsequent screening demonstrated that 50 of the 171 proteins were differentially present in at least 11/21 (52.4%) UPJO samples but undetected in control samples. To further increase the stringency of the screen, we performed an odds ratio analysis to identify the top 10 ranked proteins (FIGS. 1 b and 1 c, Table 2). NGAL/LCN2 was included in the analysis to compare the UPJO-selectivity of the top 10 ranked proteins to this acknowledged biomarker. LCN2 was present in 6/16 control samples and 5/17 UPJO samples, yielding a low odds ratio (0.8) when compared to the odds ratios of the top 10 proteins (ranging from 6.3-45). Additionally, neither KIM-1 nor cystatin C were detected in our mass spectrometry analysis, potentially due to their low abundance in comparison to the 10 selected proteins, further underscoring that these top 10 proteins may be superior prognostic markers of UPJO.

TABLE 2 Average precursor intensity values of candidate biomarker proteins in control and UPJO patient urine samples. ISLR QPRT SPARCL1 FGG SPRR3 BASP1 PTGR1 CFH VCAM1 FCN2 LCN2 Control-1 1.5E+06 0 0 0 0 0 0 0 0 0 0 Control-2 0 0 0 1.7E+07 0 0 0 8.1E+06 0 0 3.7E+06 Control-3 0 0 0 0 0 0 0 0 0 0 0 Control-4 0 0 0 0 0 0 0 0 0 0 0 Control-5 0 0 0 0 0 0 0 0 0 0 0 Control-6 0 0 0 0 0 0 0 0 0 0 0 Control-7 0 0 0 0 0 0 1.1E+06 0 0 0 0 Control-8 0 0 0 0 0 0 0 0 0 0 0 Control-9 1 0 0 0 0 0 0 0 0 0 0 Control-10 0 0 0 0 0 0 0 0 0 0 3.4E+06 Control-11 0 0 0 0 0 0 0 0 0 1.8E+06 0 Control-12 0 0 0 0 0 0 0 0 0 1.5E+06 0 Control-13 0 0 0 0 0 0 0 0 0 0 0 Control-14 0 0 0 0 0 3.9E+06 0 0 0 0 1.8E+06 Control-15 0 1 0 0 0 0 0 0 0 0 2.7E+06 Control-16 0 0 0 0 0 0 0 0 0 0 0 Control-17 0 0 4.2E+06 0 0 0 0 6.6E+06 4.7E+06 0 0 Control-18 0 0 0 0 0 0 0 0 0 0 0 Control-19 0 0 0 0 0 0 1.6E+06 0 0 0 3.4E+06 Control-20 0 5.9E+06 0 1.2E+07 5.2E+06 9.7E+06 1.0E+07 3.1E+06 1.3E+07 0 1.6E+06 Control-21 0 0 0 0 2.4E+07 0 0 0 0 3.0E+06 0 Control-22 0 0 0 0 0 0 0 0 6.3E+05 0 0 UPJO-2 3.0E+06 0 1.5E+07 4.1E+06 0 1.0E+07 0 2.9E+06 1.5E+06 6.9E+06 0 UPJO-3 3.3E+06 0 1 2.9E+06 0 1.8E+06 0 2.0E+06 4.0E+05 0 0 UPJO-4 3.3E+06 0 5.1E+06 0 0 2.3E+06 0 1 0 0 0 UPJO-5 5.0E+06 5.1E+06 7.3E+06 0 2.0E+06 3.2E+06 0 0 4.8E+06 3.2E+06 1.4E+06 UPJO-6 0 0 0 3.7E+07 4.6E+06 8.9E+06 2.1E+06 2.9E+07 0 1 9.7E+06 UPJO-7 0 1.3E+06 4.7E+06 0 0 3.7E+06 3.0E+06 0 2.5E+06 0 0 UPJO-8 2.1E+06 1.4E+06 4.8E+06 4.9E+06 1 4.5E+06 9.3E+05 1 4.1E+06 0 0 UPJO-9 4.5E+06 0 1.0E+07 3.0E+06 6.9E+06 7.7E+06 0 1.9E+06 0 3.6E+06 0 UPJO-10 9.8E+06 2.4E+06 2.0E+07 3.2E+06 5.0E+06 1.3E+07 0 5.4E+06 5.7E+06 1.2E+07 0 UPJO-11 3.5E+06 0 9.2E+06 6.2E+06 1 6.1E+06 0 4.5E+06 2.2E+06 6.1E+06 0 UPJO-12 3.2E+06 4.3E+06 2.5E+07 1.1E+07 4.9E+06 1.4E+07 5.1E+06 5.8E+06 1.1E+07 1.6E+07 0 UPJO-13 0 0 0 0 6.4E+06 0 9.5E+05 1.2E+06 0 0 0 UPJO-14 2.8E+06 3.6E+06 0 3.5E+07 1.8E+07 8.2E+06 3.7E+06 9.5E+06 0 0 0 UPJO-15 2.1E+06 6.8E+06 1.2E+07 1.2E+07 0 1.3E+07 5.8E+06 3.3E+06 3.7E+06 6.6E+06 1.8E+06 UPJO-16 6.7E+06 1.9E+07 0 2.6E+07 3.6E+07 1.3E+07 8.8E+06 5.0E+06 3.9E+06 0 0 UPJO-17 3.1E+06 4.3E+06 0 8.7E+06 1 0 2.4E+06 1.8E+06 0 0 0 UPJO-18 1.8E+06 4.4E+06 2.3E+07 3.3E+07 1.6E+07 1.8E+07 1.2E+07 8.6E+06 1.1E+07 5.6E+06 1.0E+07 UPJO-19 0 0 0 0 5.2E+07 0 0 2.7E+06 0 3.5E+06 0 UPJO-20 0 0 0 0 0 0 0 0 0 0 0 UPJO-21 2.1E+06 2.6E+06 0 9.5E+06 1.7E+07 3.9E+06 3.2E+06 2.6E+06 0 1.4E+06 0 UPJO-22 0 0 0 0 4.5E+07 0 0 0 0 3.0E+06 1.8E+06 Values are average precursor intensities denoted as counts per unit time. LCN2 is included for comparative analysis.

PTGR1, FCN2, QPRT, ISLR and VCAM1 Form a Panel of UPJO-Inherent Biomarker Proteins

To determine quantitative values and relative changes, highly sensitive ELISA assays with larger dynamic range were performed for each of the top 10 proteins and normalized to urine creatinine concentrations. The average creatinine concentration in UPJO samples [Ave(SD)−6.11(3.7)mg/dL] was consistently lower than that of the control samples [Ave(SD)−36.42(19.5)mg/dL]. Concentrations of BASP1, FGG and SPRR3 proteins were below the detection limit in all the samples and subsequently excluded from the panel. Similarly, SPARCL1 and CFH were detected in only a few samples and were also removed from further analysis. However, the normalized concentrations of PTGR1, FCN2, QPRT, ISLR and VCAM1 were significantly higher in the UPJO samples (FIG. 2a ) with fold-change (UPJO/Control) of the median protein concentrations ranging from 2.9-9.4 (FIG. 2b ), further validating their potential as UPJO biomarkers.

To categorize individual control and UPJO samples, we used the average+3(SD) and average+4(SD) values for each of the 5 proteins in the control samples as an arbitrary cutoff to determine the number of individual control and UPJO samples that have values exceeding the cutoff value. Of the 18 UPJO samples, only one sample (UPJO-1) had a value beneath that of the control cutoff value for all 5 proteins, while the remaining 17 samples had at least 1 protein present with a value above the cutoff value (FIG. 2c ). Additionally, barring UPJO-5, the remaining 16 samples contain at least 2 proteins at levels above the cutoff value (FIG. 2c ). Alternatively, only one control sample (control-16) had PTGR1 and QPRT present at above the respective cutoff value while the remaining controls were below (Table 3).

TABLE 3 Classification of control samples based on the respective average + 3(SD) control value Control samples with values greater than the Average + 3(SD) value of control samples % Positive Sample PTGR1 FCN2 QPRT ISLR VCAM1 proteins Control-1 x x x x x (0/5) 0% Control-2 ND ND x x x (0/3) 0% Control-3 x x x x x (0/5) 0% Control-4 x x x x x (0/5) 0% Control-5 x x x x x (0/5) 0% Control-6 x x x x x (0/5) 0% Control-7 x x x x x (0/5) 0% Control-8 x x x x x (0/5) 0% Control-9 x x x x x (0/5) 0% Control-10 x x x x x (0/5) 0% Control-11 x x x x x (0/5) 0% Control-13 x x x x x (0/5) 0% Control-14 ND ND ND x x (0/2) 0% Control-15 x x x x x (0/5) 0% Control-16 YES x YES x x (2/5) 40% Control-17 x x x x x (0/5) 0% Control-18 ND ND x x x (0/3) 0% Control-19 x x x x x (0/5) 0% Control-20 x x x x x (0/5) 0% Control-21 x x x x x (0/5) 0% Control-22 x x x x x (0/5) 0% Positive 1/18 0/18 1/20 0/21 0/21 samples (5.56%) (0%) (5%) (0%) (0%) (%) ND—not determined, SD—standard deviation

Increasing the stringency to average +4(SD) cutoff value eliminated the only positive control sample, while retaining a similar distribution in the UPJO samples (FIG. 2D). Finally, the order of prevalence of the 5 proteins in UPJO samples is

PTGR1>FCN2>QPRT>ISLR>VCAM1.

In summary, we identified a panel of urinary biomarker proteins that, when screened collectively, may reliably distinguish between obstructed vs. non-obstructed infants.

Discussion

In this study, we identified a panel of 5 unique proteins that form a UPJO-inherent signature. To achieve this, we minimized variability by selecting a specific cohort of patients who are at the greatest risk and avoided pooling of different age groups that can confound the results. Additionally, only males were included since males are more frequently affected than females (2-3:1). We also established a unique methodology to identify candidate biomarker proteins by choosing proteins that are absent in most control samples rather than choosing proteins that are present in both samples at quantitatively different levels. Although these proteins were detected in some control samples by ELISA analysis, the fold difference was significantly higher with UPJO.

Hydronephrosis can lead to progressive cellular damage due to hypoxia, reactive oxygen species and fibrosis, ultimately resulting in tubular cell death and interstitial inflammation. Considering the multi-dimensional effects of obstruction, it is logical that we identified a diverse biomarker protein panel. Mechanistically, these biomarker proteins are detectable in the urine due to increased release, reduced renal reabsorption or both.

PTGR1 is an enzyme that mediates catabolism of eicosanoids and is highly expressed in kidney tubular cells, cancer cells and aids in cell proliferation and oxidative stress tolerance. Considering the increased oxidative stress on an obstructed kidney, high levels of PTGR1 could be released in the urine due to tubular cell death. Accordingly, PTGR1 was the most prevalent protein in our cohort of UPJO samples (16/18). Similarly, QPRT, an enzyme essential for the synthesis of nicotinamide adenine dinucleotide (NAD⁺) protects kidneys from acute injury. FCN2, a plasma pattern recognition receptor inhibits epithelial to mesenchymal transition (EMT) of hepatocellular carcinoma by reducing TGF-β signaling. Inhibition of EMT of tubular epithelial cells would be expected to prevent fibrosis in obstructed kidneys and therefore increased FCN2 and QPRT could be early defense mechanisms seen in our cohort of young infants.

Mesenchymal stromal cells (MSCs) in fetal kidney are essential for the differentiation of nephrons and the undifferentiated nature of MSCs is maintained by ISLR, thus the initial observation of ISLR expression in fetal but not adult kidney as well as in our cohort of patients. VCAM1, an inflammation-induced endothelial cell adhesion molecule, is a urinary biomarker for kidney injury in lupus nephritis and in women with preeclampsia.

While our biomarker panel is established by comparing the two extremes of obstruction, confirmed vs. non-obstructed, we are currently collecting samples from patients with equivocal renal scan findings in both sexes to evaluate the panel's utility in a diverse patient population. Overall, this unique screening strategy led to the identification of previously unknown biomarker proteins and is useful in identifying informative biomarker panels for biological samples from many diseases.

Methods Participants and Urine Samples

De-identified control (n=22) and UPJO (n=22) patients' urine samples were collected with consent from parents and in accordance with an approved IRB protocol (#070-18-EP) from Children's Hospital and Medical Center, Omaha, Nebr. Frozen urine samples were shipped to UConn Health according to an approved material transfer agreement. Patient cohort consists of males (<2 years) with proven UPJ obstruction (Mag-3 t½>20 min, differential function decrease >10%) undergoing surgical repair. Urine specimens were collected upon catheterization for the Mag-3 study according to standard renogram protocol. Controls are age-matched males undergoing hypospadias repair with no associated renal anomalies.

Creatinine Assay and ELISA

All the experiments were performed according to the manufacturer's instructions. Creatinine levels were determined using creatinine assay kit (KGE005, R&D systems, MN, USA). Human FCN2 (ab213778), CFH (ab213765) and SPARCL1 (ab213826) ELISA kits were purchased from Abcam, MA, USA. Human PTGR1 (366461) and ISLR (152702) kits were purchased from US Biological, MA, USA. Human FGG (LS-F7036), BASP1 (OKCD02007), VCAM1 (KHT0601), QPRT (NBP2-60595) and SPRR3 (MB S2602661) ELISA kits were purchased from LifeSpan Biosciences, WA, USA; Aviva systems biology, CA, USA; Thermo Fisher scientific, MA, USA; Novus Biologicals, CO, USA and MyBioSource, CA, USA, respectively.

Statistical Analyses

GraphPad™ Prism was used to perform statistical analyses. Values from individual experiments were tested for normal distribution by Kolmogorov-Smirnov test. Normally distributed values were compared using 2-tailed Student's t test, while non-normally distributed values were compared using Mann-Whitney U test and significance was determined (*p≤0.05, **p≤0.01, ***p≤0.001). All the p values from Kolmogorov-Smirnov test, Student's t test and Mann-Whitney U test have been tabulated in the Supplementary File 3.

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Supplemental Methods Mass Spectrometry Analysis

Total protein content in the urine samples was determined and 1 mL of each sample was mixed with 8 mL of ice-cold acetone and incubated at −20° C. for 1 hour. Samples were centrifuged at 11,000 g for 30 minutes and supernatant was discarded. Pellets were washed with 5 mL of ice-cold acetone and centrifuged at 11,000 g for 30 minutes. Protein pellets were air dried and stored at −80° C. Quantitative label-free mass spectrometry-based proteomics analysis was performed at the UConn Proteomics and Metabolomics Facility.

Urinary Proteomics Sample Preparation

Following protein precipitation and resuspension, an aliquot of each sample containing 100 ug of total protein was removed, dried to completion using a Labconco speedvac concentrator, and reconstituted in 100 μL 0.1 M ammonium bicarbonate in water (pH 8.0). Proteins were then subjected to Cys reduction and alkylation using 5 mM dithiothreitol in 0.1M ammonium bicarbonate (1.5 hours at 37° C.) and 10 mM iodoacetamide in 0.1M ammonium bicarbonate (45 minutes at 37° C. in the dark), respectively. Proteins were digested using sequencing grade modified trypsin (Promega, P/N V5113) at a 1:20 enzyme:protein ratio in a thermal mixer at 37° C. for 16 hours. Proteolysis was quenched by the addition of formic acid to a final pH of 2.5. Tryptic peptides were desalted using Pierce C18 Desalting Spin Columns (P/N 89851) by following manufacturer's instructions. Desalted peptides were dried in a speedvac concentrator, resuspended in 0.1% formic acid in water, and frozen at −20° C. until further analysis.

Quantitative, Label-Free Mass Spectrometry-Based Proteomics Analysis

Tryptic peptides were quantified using a spectrophotometer (Protein A280 mode, Thermo Scientific) and diluted using 0.1% formic acid to provide uniform peptide concentrations across all samples. Peptides were injected into and separated using nanoflow ultra-high performance liquid chromatography and immediately mass analyzed using high resolution tandem mass spectrometry (Thermo Scientific Q Exactive™ HF mass spectrometer). The nanoflow separation implemented a 1 hour linear gradient (Solvent A: 0.1% formic acid in water, Solvent B: 0.1% formic acid in acetonitrile) at 300 nL/min flow rates over a 2 μm, 100 Å, 75 μm×25 cm Easy Spray PepMap™ C18 analytical column (Thermo Scientific) held at 35° C. Eluted peptides were directly ionized using electrospray ionization into the Q Exactive™ HF mass spectrometry which was operated using the following parameters: positive ESI mode, MS1 mass range 300-1800 Da with 60,000 resolution, Top 15 DDA MS/MS acquisition, MS2 resolution of 15,000, 27 NCE and charge state exclusion “on” for unassigned, +1 and >+8 charge states.

All raw files were searched against the Uniprot Homo sapiens reference proteome database (accessed 2017 Apr. 22) using Andromeda™ and Maxquant™ software (v1.6.0.1) for peptide identification and label-free quantitation, respectively.¹ The following parameters were used for peptide/protein identification: 1% False Discovery Rate at the protein and peptide levels, variable modifications: oxidation of Met, N-terminal protein acetylation, and N-terminal peptide Gln to pyro Glu, fixed carbamidomethylation on Cys, trypsin cleavage specificity with 2 missed cleavages, 5 amino acids/peptide minimum, and MaxQuant™ LFQ “on”. All other parameters were kept at default values. Search results were uploaded into Scaffold v4.9 (Proteome Software, Inc.) for data visualization and further analysis.

REFERENCES

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We claim:
 1. A method for prognosing or diagnosing an obstructive renal dysfunction in a subject, comprising: (a) detecting in a urine sample from a subject one or more proteins selected from the group consisting of Immunoglobulin superfamily containing leucine-rich repeat protein (ISLR); Nicotinate-nucleotide pyrophosphorylase [carboxylating] (QPRT); Prostaglandin reductase 1 (PTGR1); Vascular cell adhesion protein 1 (VCAM1); and Ficolin-2 (FCN2), or detectable portions thereof; and (b) comparing an amount of the one or more proteins in the urine sample to a standard; wherein an amount of at least one of the one or more proteins in the urine sample above the standard identifies the subject as at risk of or having an obstructive renal dysfunction.
 2. The method of claim 1, wherein an amount of at least one of the one or more proteins in the urine sample above the standard identifies the subject as at risk of or having an obstructive renal dysfunction resulting from ureteropelvic junction obstruction (UPJO).
 3. The method of claim 1, wherein the standard comprises a normal range determined from subjects not having an obstructive renal dysfunction.
 4. The method of claim 2, wherein the standard comprises a normal range determined from subjects not having UPJO.
 5. The method of claim 1, wherein an amount of at least two, three, four, or all five of the one or more proteins in the urine sample above the standard identifies the subject as at risk of or having an obstructive renal dysfunction.
 6. The method of claim 1, wherein an amount of PTGR1 in the urine sample above the standard identifies the subject as at risk of or having an obstructive renal dysfunction.
 7. The method of claim 1, wherein an amount of PTGR1 and FCN2 in the urine sample above the standard identifies the subject as at risk of or having an obstructive renal dysfunction.
 8. The method of claim 1, wherein an amount of PTGR1, FCN2, and QPRT in the urine sample above the standard identifies the subject as at risk of or having an obstructive renal dysfunction.
 9. The method of claim 1, wherein the subject is under 2 years of age.
 10. The method of claim 1, wherein the detecting comprises contacting the urine sample with antibodies that bind to the one or more proteins, and detecting binding of the antibodies to the one or more proteins.
 11. The method of claim 10, wherein the detecting comprises an enzyme-linked immunosorbent assay (ELISA).
 12. The method of claim 1, wherein the method comprises identifying the subject as having an obstructive renal dysfunction, and wherein the method further comprises treating the subject for the obstructive renal dysfunction.
 13. The method of claim 2, wherein the method comprises identifying the subject as having UPJO, and wherein the method further comprises treating the subject for UPJO.
 14. The method of claim 12, further comprising; (a) detecting one or more proteins selected from the group consisting of ISLR, QPRT, PTGR1, VCAM1, and FCN2, or detectable portions thereof, in a urine sample from a subject that has undergone treatment for the obstructive renal dysfunction; and (b) comparing an amount of the one or more proteins in the urine sample to a standard; wherein a decrease in the amount of the or more (1, 2, 3, 4, or all 5) proteins in the urine sample relative to the standard indicates the treatment was effective; or wherein no change or an increase in the amount of the one or more (1, 2, 3, 4, or all 5) proteins in the urine sample relative to the standard indicates the treatment was ineffective.
 15. The method of claim 13, further comprising; (a) detecting one or more proteins selected from the group consisting of ISLR, QPRT, PTGR1, VCAM1, and FCN2, or detectable portions thereof, in a urine sample from a subject that has undergone treatment for the UPJO; and (b) comparing an amount of the one or more proteins in the urine sample to a standard; wherein a decrease in the amount of the or more (1, 2, 3, 4, or all 5) proteins in the urine sample relative to the standard indicates the treatment was effective; or wherein no change or an increase in the amount of the one or more (1, 2, 3, 4, or all 5) proteins in the urine sample relative to the standard indicates the treatment was ineffective.
 16. A composition, comprising antibodies that specifically bind 2, 3, 4, or all 5 proteins selected from the group consisting of ISLR, QPRT, PTGR1, VCAM1, and FCN2, or antigen binding portions thereof.
 17. The composition of claim 16, wherein the composition comprises antibodies that specifically bind 1, 2, or all 3 of PTGR1, FCN2, QPRT, or antigen binding portions thereof.
 18. The composition of claim 16, wherein the composition comprises (a) antibodies that specifically bind PTGR1, or antigen binding portions thereof; and (b) antibodies that specifically bind FCN2, or antigen binding portions thereof.
 19. The composition of claim 16, wherein the composition comprises (a) antibodies that specifically bind PTGR1, or antigen binding portions thereof; (b) antibodies that specifically bind FCN2, or antigen binding portions thereof; and (c) antibodies that specifically bind QPRT, or antigen binding portions thereof.
 20. The composition of claim 16, wherein the composition comprises (a) antibodies that specifically bind PTGR1, or antigen binding portions thereof; (b) antibodies that specifically bind FCN2, or antigen binding portions thereof; (c) antibodies that specifically bind QPRT, or antigen binding portions thereof; (d) antibodies that specifically bind ISLR, or antigen binding portions thereof; and (e) antibodies that specifically bind VCAM1, or antigen binding portions thereof.
 21. The composition of claim 16, wherein the antibodies are immobilized on a surface of a solid support, and/or wherein the antibodies are detectably labeled, such as fluorescently labeled, radioactively labeled, or colorimetrically labeled. 